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Treatment-resistant head lice are forcing parents to nitpick — literally.

Old-school techniques including grooming a child’s head with a fine-tooth nit comb are making a comeback as lice-killing insecticides lose their effectiveness around the world.

Yet health authorities in Metro Vancouver still tell parents that over-the-counter insecticidal shampoos and conditioners are viable solutions along with repeated nit combing.

“It’s because there are not too many chemical options, they need to recommend something,” says University of British Columbia entomologist Yasmin Akhtar in the Faculty of Land and Food Systems. “Parents need to understand that there are other options ... Our recommendations are time-consuming and parents may not have the patience for using them,” she says.

Misuse and overuse of these insecticidal treatments over time have created resistance in head lice, much in the same way that bed bugs have become a difficult-to-kill pest in cities throughout North America, says Akhtar.

Research from the University of Massachusetts published in March found that 99.6 per cent of head lice samples collected in the U.S. from 2007 to 2009 carried a gene making them resistant to widely used treatments containing pyrethrins or permethrins, natural or synthetic versions of insecticidal compounds derived from the chrysanthemum plant. In Canada, the rate was 97 per cent.

That has spawned businesses like Lice 911 in Maple Ridge that takes on the tedious task of painstakingly combing a head of hair — section by section — until the pests are gone. Owner Barb Pattison and her five employees charge $60 per hour for the service; it takes a couple of hours to comb out a head of long hair on a 12-year-old girl, for instance. And that has to be repeated every three days for two or three weeks.

Pattison tells parents that if they want to use insecticidal shampoo, they need to do it every seven days to catch nymphs as they hatch. “They’re not going to work the way the package says.”

After a decade in business, Pattison says the nature of her clients has changed in the past two years. It used to be only elementary school-aged kids, but now more teenagers are showing up. It’s a trend she chalks up to the popularity of long hair on girls and boys and group ‘selfies’ that have teens cheerfully holding their heads together long enough to get the perfect shot.

“What we’re seeing now is teenagers who are not in a traditionally high-risk situation like having younger siblings at home or volunteering in a daycare. It’s the ‘selfie’ situation,” she says.

Head lice do not jump or fly, but crawl very quickly and are typically passed by head-to-head contact or by sharing hats, helmets and brushes. They cannot survive without a host for more than 48 hours.

Of Lice 911’s 26 current files, 12 involve families with teens and no younger kids at home, something Pattison says she wouldn’t have seen five years ago.

Health officials in Canada don’t track the number of head lice cases because the pests don’t carry disease. Schools no longer ask parents to keep kids home if they have lice, partly because it’s so common that many children would miss too much school and also to lessen the stigma around lice.

“Lice do not discriminate,” says Shayne Reilly, a public health nurse with Vancouver Coastal Health. “We see it on the west side as well as the east side. We see it all year round and lice like clean hair as much as dirty hair.”

He says the health authority’s advice on treating lice offers a variety of options because some parents won’t go near insecticidal hair treatments and others embrace them. He notes that improper application, not leaving it on long enough, diluting it or treating everyone in the family even though only one person has an active case have all contributed to the problem of resistance.

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